TY - JOUR
AU - Stickels, Christian P
AU - Nadarajah, Ramesh
AU - Gal, Chris P
AU - Jiang, Houyuan
AU - Sharkey, Kieran J
AU - Gibbison, Ben
AU - Holliman, Nick
AU - Lombardo, Sara
AU - Schewe, Lars
AU - Sommacal, Matteo
AU - Sun, Louise
AU - Weir-McCall, Jonathan R.
AU - Cheema, Kate
AU - Rudd, James H F
AU - Mamas, Mamas A.
AU - Erhun, Feryal
PY - 2022
DA - June
TI - Aortic stenosis post-COVID-19: A mathematical model on waiting lists and mortality
JO - BMJ Open
VL - 12
IS - 6
DO - http://dx.doi.org/10.1136/bmjopen-2021-059309
AB - Objectives To provide estimates for how different treatment pathways for the management of severe aortic stenosis (AS) may affect NHS England waiting list duration and associated mortality. Design We constructed a mathematical model of the excess waiting list and found the closed-form analytic solution to that model. From published data, we calculated estimates for how the following strategies may affect the time to clear the backlog of patients waiting for treatment and the associated waiting list mortality. Interventions 1) increasing the capacity for the treatment of severe AS, 2) converting proportions of cases from surgery to transcatheter aortic valve implantation, and 3) a combination of these two. Results In a capacitated system, clearing the backlog by returning to pre-COVID-19 capacity is not possible. A conversion rate of 50% would clear the backlog within 666 (95% CI, 533–848) days with 1419 (95% CI, 597–2189) deaths whilst waiting during this time. A 20% capacity increase would require 535 (95% CI, 434–666) days, with an associated mortality of 1172 (95% CI, 466–1859). A combination of converting 40% cases and increasing capacity by 20% would clear the backlog within a year (343 (95% CI, 281–410) days) with 784 (95% CI, 292–1324) deaths whilst awaiting treatment. Conclusion A strategy change to the management of severe AS is required to reduce the NHS backlog and waiting list deaths during the post-COVID-19 ‘recovery’ period. However, plausible adaptations will still incur a substantial wait and many hundreds dying without treatment.
PB - BMJ Publishing Group
UR - https://www.research.ed.ac.uk/en/publications/c9d2756b-6762-43ec-ba1a-0e1513d3e0c8
KW - Coronavirus (COVID-19)
KW - Hospital care
ER